Account Credit Application
Sold To Name
Ship To Name
Sold To Address
Ship To Address
Sold To City
Ship To City
Sold To State
Ship To State
Sold To Zip
Ship To Zip
Phone
Fax
       
 
President / Owner
  
 
Purchasing Agent
  
 
Accounts Payable Contact
  
 
Company Type
  
 
Tax ID or SS#
  
 
Tax Exempt # (Please send copy of tax exempt form or resale certificate)
  
 
Number of Employees
  
 
Type of Shop
  
     
 
Bank Information
  
 
Name
  
 
Address
  
 
City
  
 
State
  
 
Zip
  
 
Contact
  
 
Phone
  
       
 
Credit References
 
       
  Credit Reference #1 Credit Reference #2 Credit Reference #3
Name
Address
City
State
Zip
Phone
Fax
       
 
 
 

 
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